Journal of Oral and Maxillofacial Surgery最新文献

{"title":"A Novel Bipartite 3D Printed CAD/CAM Splint for Treatment of Mandibular Fractures.","authors":"Varad Rajendra Saptarshi, Srivalli Natarajan, Suraj Arjun Ahuja, Chinmay Vasant Rao","doi":"10.1016/j.joms.2025.04.019","DOIUrl":"10.1016/j.joms.2025.04.019","url":null,"abstract":"","PeriodicalId":16612,"journal":{"name":"Journal of Oral and Maxillofacial Surgery","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144078739","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Autografts, Bone Substitutes, and Combined Approaches for Secondary Alveolar Bone Grafting: A Systematic Review and Meta-Analysis.","authors":"Saman Baghaei, Masood Feizbakhsh, Bijan Movahedian Attar, Alireza Khoshdel, Hossein Abdali","doi":"10.1016/j.joms.2025.04.018","DOIUrl":"10.1016/j.joms.2025.04.018","url":null,"abstract":"<p><strong>Background: </strong>Alveolar clefts require bone grafting to restore function and esthetics. Although autogenous iliac crest grafts remain gold standard, their morbidity motivates exploration of alternative materials.</p><p><strong>Purpose: </strong>This systematic review and meta-analysis evaluated 3 approaches to alveolar cleft repair: 1) autogenous bone grafts combined with alternative bone substitute materials (group A), 2) alternative bone substitutes alone (group B), and 3) autogenous iliac crest grafts as the reference standard (group C). Outcomes such as bone density, volume, height, bone formation rates, operative time, and recovery were compared to guide clinical decision-making.</p><p><strong>Data sources: </strong>A comprehensive search was conducted across the Scopus, PubMed, Web of Science, Cochrane Central, and Embase databases for studies published between January 1, 2000, and July 18, 2024. Medical Subject Heading terms and keywords related to alveolar cleft repair and bone grafting techniques were used, with studies limited to the English-language and peer-reviewed randomized controlled trials.</p><p><strong>Study selection: </strong>Inclusion criteria focused on randomized controlled trials evaluating secondary alveolar bone grafting with a minimum 6-month follow-up, involving radiographic assessments of cleft regions. Studies on patients with syndromes or primary dentition grafting were excluded. As a result, 3,962 articles were first identified, 15 studies entered the final full evaluation, and eventually, 10 studies with 186 patients met the final criteria.</p><p><strong>Data extraction and synthesis: </strong>Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines (PRISMA flowchart) were followed, with independent reviewers extracting the data. The risk of bias was assessed using Consolidated Standards of Reporting Trials guidelines. Outcomes were pooled using fixed- and random-effects models as appropriate.</p><p><strong>Main outcome(s) and measure(s): </strong>The primary outcomes included bone volume, density, height, and bone formation rate. The secondary outcomes were the operative time, hospital stay, and blood loss.</p><p><strong>Results: </strong>Group A achieved the highest bone density and volume retention at 6 and 12 months. Group C demonstrated superior bone formation rates and height but posed greater surgical challenges. Group B offered logistical advantages with reduced invasiveness, but underperformed bone density and formation. These findings emphasize the need for tailored approaches that balance efficacy and patient-specific considerations.</p><p><strong>Conclusions and relevance: </strong>These findings underscore the need for personalized approaches in alveolar cleft repair, balancing effectiveness, and patient-specific considerations. Enhanced materials and standardized protocols are vital for optimizing outcomes.</p>","PeriodicalId":16612,"journal":{"name":"Journal of Oral and Maxillofacial Surgery","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-04-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144191947","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Computed Tomography-Based Predictors of Difficult Intubation in Oral and Maxillofacial Surgery Patients.","authors":"Jiayi Wang, Pengcheng Zhao, Ren Zhou, Jia Yan, Hong Jiang","doi":"10.1016/j.joms.2025.04.011","DOIUrl":"10.1016/j.joms.2025.04.011","url":null,"abstract":"<p><strong>Background: </strong>The incidence of difficult airway is higher in oral and maxillofacial surgery (OMS) operations than those in general surgery. Current predictors, including clinical tools like the LEMON (Look Externally, Evaluate Mallampati Classification, Obstruction, Neck Mobility, Motion of Jaw) score, are often inaccurate, leading to underdiagnosis and increased risks to patient safety.</p><p><strong>Purpose: </strong>This study aimed to identify computed tomography (CT) findings associated with difficult intubation in patients receiving OMS operations.</p><p><strong>Study design, setting, sample: </strong>This prospective cohort study was conducted at the Shanghai Ninth People's Hospital from October 2018 to October 2021 and included patients undergoing OMS operations under general anesthesia. Exclusion criteria included individuals who received regional anesthesia, had contraindications to mask ventilation, lacked preoperative CT imaging, or did not provide informed consent.</p><p><strong>Predictor variables: </strong>The predictor variables were 21 midsagittal plane CT parameters and five 3-dimensional airway reconstruction parameters.</p><p><strong>Outcome variable: </strong>The outcome variable was ease of intubation, categorized as difficult intubation (grade III or IV laryngeal view under direct laryngoscopy) and easy intubation (grade I or II laryngeal view under direct laryngoscopy).</p><p><strong>Covariates: </strong>Covariates included demographic variables (age, weight, body mass index, and sex) and anatomical variables (modified Mallampati classification, hyoid thyroid cartilage distance, hyoid mental distance, thyromental distance, atlanto-occipital joint extension, and interincisor distance).</p><p><strong>Analyses: </strong>Least absolute shrinkage and selection operator was used to select significant variables. Logistic regression was then used to construct the predictive model. The model's performance was evaluated using receiver operating characteristic curve.</p><p><strong>Results: </strong>The study included 630 patients, with 35.2% experiencing difficult intubation. The model was composed of 10 midsagittal plane and two 3-dimensional airway reconstruction parameters from CT images, with area under the curve values of 0.78 in the training cohort (n = 336) and 0.76 in the validation cohort (n = 72). In the validation cohort, the model achieved a sensitivity of 0.74 and a specificity of 0.75. In contrast, the area under the curve value of LEMON score was 0.62.</p><p><strong>Conclusions and relevance: </strong>This study developed a CT-based model that identifies patients at risk of difficult intubation in OMS, outperforming the LEMON score and underscoring the relevance of CT parameters, particularly those involving the tongue, uvula, and hyoid bone, in guiding clinical decision-making.</p>","PeriodicalId":16612,"journal":{"name":"Journal of Oral and Maxillofacial Surgery","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144078832","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Deep-Learning Method for the Diagnosis and Classification of Orbital Blowout Fracture Based on Computed Tomography.","authors":"Suyoung Kim, Hyeon Kang Koh, Hyungwoo Lee, Hyun Jin Shin","doi":"10.1016/j.joms.2025.04.010","DOIUrl":"10.1016/j.joms.2025.04.010","url":null,"abstract":"<p><strong>Background: </strong>Blowout fractures (BOFs) are common injuries. Accurate and rapid diagnosis based on computed tomography (CT) is important for proper management. Deep-learning techniques can contribute to accelerating the diagnostic process and supporting timely and accurate management, particularly in environments with limited medical resources.</p><p><strong>Purpose: </strong>The purpose of this retrospective in-silico cohort study was to develop deep-learning models for detecting and classifying BOF using facial CT.</p><p><strong>Study design, setting, and sample: </strong>We conducted a retrospective analysis of facial CT from patients diagnosed with BOF involving the medial wall, orbital floor, or both at Konkuk University Hospital between December 2005 and April 2024. Patients with other facial fractures or those involving the superior or lateral orbital walls were excluded.</p><p><strong>Predictor variable: </strong>The predictor variables are the outputs as each model's designated categories from the deep-learning models, which include the predicted 1) fracture status (normal or BOF), 2) fracture location (medial, inferior, or inferomedial), and 3) fracture timing (acute or old).</p><p><strong>Main outcome variables: </strong>The main outcomes were the human assessments serving as the gold standard, including the presence or absence of BOF, fracture location, and timing.</p><p><strong>Covariates: </strong>The covariates were age and sex.</p><p><strong>Analyses: </strong>Model performance was evaluated using the following metrics: 1) accuracy, 2) positive predictive value (PPV), 3) sensitivity, 4) F1 score (harmonic average between PPV and sensitivity), and 5) area under the receiver operating characteristic curve (AUC) for classification models.</p><p><strong>Results: </strong>This study analyzed 1,264 facial CT from 233 patients with multiple CT slices taken from each patient in various coronal views (mean age: 37.5 ± 17.9 years; 79.8% male-186 subjects). Based on these data, 3 deep-learning models were developed for 1) BOF detection (accuracy 99.5%, PPV 99.2%, sensitivity 99.6%, F1 score 99.4%, AUC 0.9999), 2) BOF location (medial, inferior, or inferomedial; accuracy 97.4%, PPV 92.7%, sensitivity 89.0%, F1 score 90.8%), and 3) BOF timing (accuracy 96.8%, PPV 90.1%, sensitivity 89.7%, F1 score 89.9%). In addition, the BOF detection model had an AUC of 0.9999.</p><p><strong>Conclusions and relevance: </strong>Deep-learning models developed with Neuro-T (Neurocle Inc, Seoul, Republic of Korea) can reliably diagnose and classify BOF in CT, distinguishing acute from old fractures and aiding clinical decision-making.</p>","PeriodicalId":16612,"journal":{"name":"Journal of Oral and Maxillofacial Surgery","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144018185","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Risk Factors Associated With Complications in Treated Mandibular Fractures: A Retrospective Cohort Study.","authors":"Jamie Rose, Edwin M Rojas, Jameela Broadie, Boyu Ma, Somsak Sittitavornwong","doi":"10.1016/j.joms.2025.04.008","DOIUrl":"10.1016/j.joms.2025.04.008","url":null,"abstract":"<p><strong>Background: </strong>Identifying factors associated with complications in the management of mandibular trauma may improve clinical decision-making.</p><p><strong>Purpose: </strong>The purpose of this study was to identify risk factors associated with complications in management of mandible factures.</p><p><strong>Study design, setting, sample: </strong>We conducted a retrospective cohort study of participants treated at the University of Alabama at Brimingham for mandibular trauma from 2016 to 2023. Subjects under 20 years old and those with lack of follow-up were excluded.</p><p><strong>Independent variable(s): </strong>The independent variable is a set of risk factors including exposure to tobacco, alcohol, marijuana, other illicit substances, and number of substances.</p><p><strong>Main outcome variable(s): </strong>The main outcome variable was the presence of a major complication in the management of mandible fractures. Major complications included sequalae requiring hospitalization or further surgical intervention.</p><p><strong>Covariates: </strong>The covariate variables collected were demographics, injury characteristics, and treatment modality.</p><p><strong>Analyses: </strong>Descriptive statistics were used to compare average age among groups. Student's t-test, Fisher's exact test, and the Koopman asymptotic score were used for contingency table analyses. Binomial logistic regression models, adjusted to age, sex, and race, were fit to compute the adjusted odds ratio for having a complication from an independent variable. Statistical significance was set at a P value < .05. Statistical analyses were performed on GraphPad Prism 10.4.1.</p><p><strong>Results: </strong>The study sample was composed of 260 subjects who met the inclusion/exclusion criteria. The ratio of males to females was 4:1 with an average age of 42.3 (±15.7) years. The overall complication rate was 8.5%. The presence of tobacco use and illicit substance use were associated with post-treatment complications risk ratio 3.65, 95% confidence interval: (1.2 to 11.4), P = .02; risk ratio 3.69, 95% confidence interval: (1.6 to 8.0), P = .009, respectively. The use of no substances was associated with fewer post-treatment complications (P = .006).</p><p><strong>Conclusions and relevance: </strong>Tobacco use and illicit substance use were associated with higher complication rates in the management of mandibular fractures. Refrainment from substance use in general was associated with fewer complications. Surgeons may use this information to guide clinical decision-making and discussions of consent when counseling patients with these injuries.</p>","PeriodicalId":16612,"journal":{"name":"Journal of Oral and Maxillofacial Surgery","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144016166","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pre-emptive Montelukast and Its Effect on Clinical Outcomes After Mandibular Third Molar Surgery: A Triple-blinded Randomized Controlled Trial.","authors":"Jitendra Chawla, M A Bari Siddiqui, Yerragudi Navaneeth, Vinoth Kumar Kalidos, Cheranjeevi Jayam, Shikha Yadav, Samarjit Dey","doi":"10.1016/j.joms.2025.04.005","DOIUrl":"https://doi.org/10.1016/j.joms.2025.04.005","url":null,"abstract":"<p><strong>Background: </strong>Cyclooxygenase inhibitors are well-studied for pain and swelling control after mandibular third molar extraction, while the lipoxygenase pathway and leukotriene receptor antagonists, like montelukast, remain less researched.</p><p><strong>Purpose: </strong>The purpose of the study was to measure and compare postoperative pain relief from single pre-emptive doses of montelukast and etoricoxib.</p><p><strong>Study design: </strong>The investigators conducted a triple-blinded, placebo-controlled randomized clinical trial and enrolled a sample of patients who presented to the All India Institute of Medical Sciences, Mangalagiri, between January 2023 and April 2023 for evaluation and management of impacted lower third molars. Patients with active inflammation or infection in the third molar region were excluded from the study.</p><p><strong>Predictor variable: </strong>The predictor variable was pre-emptive analgesic regimen: montelukast, etoricoxib, or a placebo, and subjects were randomly assigned to 3 groups.</p><p><strong>Outcome variable(s): </strong>The primary outcome variable was the intensity of postoperative pain, measured using an 11-point visual analog scale at 0, 2, 4, 6, 8, 10, 12, 24, 48, 72 hours, and 7 days postsurgery. Secondary outcome variables included changes in tissue tumor necrosis factor-alpha levels, the need for rescue analgesia, edema, and trismus.</p><p><strong>Covariates: </strong>The study covariates included demographic and surgical characteristics.</p><p><strong>Analyses: </strong>Bivariate analyses were conducted using the χ² test or one-way ANOVA, while univariate analysis utilized repeated-measures ANOVA to assess outcome changes over time, followed by post-hoc comparisons for group differences. Statistical significance was set at P < .05.</p><p><strong>Results: </strong>Forty-eight participants were randomized into 3 equal groups of 16, with no statistically significant differences in clinicoradiographic or surgical characteristics (P > .2). At 2 hours postoperatively, the mean pain score was significantly lower in the etoricoxib group (2.19 ± 2.0) compared to the montelukast and placebo groups (3.06 ± 1.6 and 4.13 ± 1.9, respectively) (P = .01; 95% CI: -3.60 to -0.27). Repeated-measures ANOVA revealed a statistically significant interaction between time and treatment group (P = .008). Post hoc analysis showed significantly lower pain intensity at 2 hours in the etoricoxib group compared to the placebo group (P = .01; 95% CI: -3.60 to -0.27).</p><p><strong>Conclusion: </strong>In third molar surgery, pre-emptive etoricoxib reduced postoperative pain, while montelukast decreased inflammation and modulated tumor necrosis factor-alpha levels. The results of the study do not support the use of the alternative pre-emptive analgesic regimens.</p>","PeriodicalId":16612,"journal":{"name":"Journal of Oral and Maxillofacial Surgery","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143969427","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Does Lingual Frenotomy Improve Breastfeeding in Newborns With Ankyloglossia? A Randomized Controlled Trial.","authors":"Lisa A Dinh, Mohamed El-Rabbany, Sadaf Aslam, Pat Ricalde","doi":"10.1016/j.joms.2025.04.006","DOIUrl":"10.1016/j.joms.2025.04.006","url":null,"abstract":"<p><strong>Background: </strong>The management of ankyloglossia and its impact on breastfeeding remains a controversial issue with limited scientific evidence, particularly regarding the utility of frenotomies.</p><p><strong>Purpose: </strong>The study purpose was to determine the effects of lingual frenotomy on improving breastfeeding effectiveness and pain in newborns with ankyloglossia.</p><p><strong>Study design, setting, and sample: </strong>We conducted a double-blind randomized controlled trial at Tampa General Hospital from April 2015 to October 2017. Eligible mother-newborn couplets with breastfeeding difficulties and ankyloglossia were randomized to frenotomy or sham procedure. Exclusion criteria included prematurity, older than 2 weeks, craniofacial anomalies, neurological compromise, or maternal conditions affecting milk supply.</p><p><strong>Predictor variable: </strong>The predictor variable was lingual frenum management, and newborns were randomly assigned in a 1:1 allocation to frenotomy or sham procedure.</p><p><strong>Outcome variables: </strong>The outcome variables were the changes in LATCH scores (a breastfeeding assessment tool) and maternal pain scores (using the Wong-Baker Pain Scale), assessed by a blinded lactation consultant before and immediately after the intervention.</p><p><strong>Covariates: </strong>The covariates were newborn age, gestational age, sex, race, severity of ankyloglossia, as well as maternal comorbidities.</p><p><strong>Analyses: </strong>Descriptive and multivariate linear regression analyses were conducted, with significance set at P < .05.</p><p><strong>Results: </strong>A total of 112 couplets were enrolled (55 [49%] frenotomy, 57 [1%] sham). No significant differences were observed in LATCH or pain scores between groups (LATCH: 0.02; 95% CI, 0.64 to 0.69; P = .9; and pain: 0.32; 95% CI, 0.56 to 1.19; P = .5). Similarly, the results of the multivariate linear regression analyses showed no significant differences between the 2 groups for improvements in both LATCH and pain scores (-0.11; 95% CI, -0.89 to 0.68; P = .8 and .38; 95% CI, -1.20 to 1.96; P = .6, respectively).</p><p><strong>Conclusions: </strong>The study findings did not demonstrate significant differences between lingual frenotomy and sham procedures on immediate improvements in pain or LATCH scores. Therefore, this study does not support the recommendation of a lingual frenotomy to improve breastfeeding difficulties in the immediate newborn setting.</p>","PeriodicalId":16612,"journal":{"name":"Journal of Oral and Maxillofacial Surgery","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144012344","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Does Discectomy and Reconstruction With Viable Osteochondral and Umbilical Allografts Reduce Pain and Improve Function for Intra-Articular Pain and Dysfunction?","authors":"Brandon Golub, Tjiska Conrotto, Jack Buhrow","doi":"10.1016/j.joms.2025.04.002","DOIUrl":"10.1016/j.joms.2025.04.002","url":null,"abstract":"<p><p>This case series reports short- and medium-term outcomes for patients with intra-articular pain and dysfunction who, after failing nonsurgical and minimally invasive treatments, underwent arthrotomy, discectomy, and reconstruction with cryopreserved viable osteochondral allografts wrapped in viable cryopreserved umbilical cord tissue. Inclusion criteria required failure of nonsurgical treatments and arthrocentesis or arthroscopy, placement of an interpositional allograft postdiscectomy, preoperative and postoperative pain scores, and maximum interincisal opening measurements, and at least 12 months follow-up or until treatment failure. No exclusion criteria were applied. Thirty-one subjects (33 joints) with a mean age of 51.5 years (±15.2), were included. Median follow-up was 23 months (interquartile range: 18 to 24, range: 6 to 30). Mean pain scores decreased from 8.6 (±1.06) to 2.5 (±1.73), P < .001, and mean maximum interincisal opening improved from 31.2 mm (±4.08) to 37.5 mm (±2.77), P < .001. Although the results are promising, long-term outcomes remain unclear, requiring long-term prospective cohort studies with controls to validate these findings.</p>","PeriodicalId":16612,"journal":{"name":"Journal of Oral and Maxillofacial Surgery","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143987612","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Open Versus Closed Management for Gunshot Wounds of the Mandible - Which More Frequently Achieves Satisfactory Bony Union? A Systematic Review and Meta-Analysis.","authors":"Thomas Pepper, David Powers","doi":"10.1016/j.joms.2025.04.003","DOIUrl":"https://doi.org/10.1016/j.joms.2025.04.003","url":null,"abstract":"<p><strong>Purpose: </strong>Closed management of high-energy mandibular injuries has been considered the gold standard for many years, but open management is preferable for its shorter overall treatment time. At present, there is a paucity of evidence on which to base management decisions, and as such there is a priority to review the literature to define the optimal treatment for mandibular gunshot wounds (GSWs).</p><p><strong>Method: </strong>The study design was a systematic review with meta-analyses and the protocol was designed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis statement. Electronic searches of published literature in the MEDLINE and Embase databases (1980-present) were conducted. Search terms included \"gunshot\", \"firearm\", \"mandible\", and \"jaw\". Inclusion criteria were randomized controlled trials (RCTs), cohort studies, case-control studies, and case series written in English describing studies involving patients with mandibular fractures caused by GSWs [population] containing information on treatment by either open reduction and (nonwire) internal fixation [intervention] or by closed reduction ± external fixation [comparator], and the frequency of bony union and complications [outcomes]. Meta-analysis was conducted using the Mantel-Haenszel odds ratio (OR) as the measure of effect. The quality of evidence was assessed using the Cochrane Risk of Bias 2 tool for RCTs and the Newcastle-Ottawa Scale for observational studies.</p><p><strong>Results: </strong>159 studies were identified overall of which 6 studies (3.7%; 3 observational studies and 3 RCTs) met the eligibility criteria. Due to high heterogeneity the study subtypes were analyzed separately. In the observational studies (n = 137), open management resulted in bony union 43/52 (82.7%) times, whereas closed management resulted in bony union 78/85 (91.8%) times (OR 0.40, 95% CI 0.14 to 1.15, P = .09). In the RCTs (n = 190), open management resulted in bony union 89/95 (93.7%) times, whereas closed management resulted in bony union 70/95 (73.7%) times (OR 6.86, 95% CI 2.42 to 19.46, P = .0003).</p><p><strong>Conclusion: </strong>The practicalities of treating mandibular GSWs are nuanced, and the recommendation of a one-size-fits-all management approach would be inappropriate. However, there is sufficient evidence in the findings of this systematic review to support open management as first-line treatment, with closed management considered if the former is clinically or logistically unfeasible.</p>","PeriodicalId":16612,"journal":{"name":"Journal of Oral and Maxillofacial Surgery","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-04-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144017542","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Is Abobotulinum A Superior to Onabotulinum A in Reducing Pain in Patients With Nocturnal Bruxism?","authors":"Fatih Asutay, Hilal Asutay, Ahmet Hüseyin Acar","doi":"10.1016/j.joms.2025.04.004","DOIUrl":"10.1016/j.joms.2025.04.004","url":null,"abstract":"<p><strong>Background: </strong>Botulinum toxin has been used to treat myofascial pain and nocturnal bruxism. It remains unclear whether there is a difference in efficacy between different BTX subtypes.</p><p><strong>Purpose: </strong>The purpose of this study was to measure the changes in pain and maximum incisal opening in subjects with nocturnal bruxism who received either Abobotulinum A (ABA) or Onabotulinum A (OBA) and determine which is faster and longer-acting.</p><p><strong>Study design, setting, sample: </strong>The researchers implemented a retrospective cohort study. Subjects presenting to Uzman Dentaclinic outpatient clinic in Bursa, Turkey, with nocturnal bruxism between June 2023 and June 2024 were identified from a review of the electronic medical record. Subjects with systemic diseases, taking active medications and undergoing psychotherapy were excluded from the study.</p><p><strong>Predictor variable: </strong>The predictor variable was the treatment assigned to the subjects received either ABA or OBA injections.</p><p><strong>Main outcome variable(s): </strong>The primary outcome variable is therapeutic response as evidenced by changes in preoperative and postoperative pain score and maximum mouth opening. The secondary outcomes were the time to onset and duration of therapeutic response.</p><p><strong>Covariates: </strong>The covariates included demographics (age, sex) and preoperative (duration of complaint) variables. The postoperative covariates were postinjection discomforts and complications.</p><p><strong>Analyses: </strong>χ² tests were used to analyze categorical data. Unpaired t-tests, Friedman test and Mann-Whitney U test were used to analyze continuous data. Results were considered significant at a P value of <.05.</p><p><strong>Results: </strong>The sample included 100 subjects with a mean age of 35.32 ± 9.11 years (OBA group, 33.78 ± 8.36 years; ABA group, 36.86 ± 9.64 years) (P = .09). There were 8 men (16%) and 42 women (84%) in the OBA group, and 10 men (20%) and 40 women (80%) in the ABA group (P = .6). There were no statistically significant differences between the groups in terms of visual analog scale scores and maximum mouth opening values at 2 weeks, 1 month, 3 months, 4 months, and 6 months (P ˃ .05). The ABA and OBA groups showed statistically significant differences in the onset of the treatment effect (11.18 ± 2.93 days [95% CI: 10.36 to 11.99] vs 8.69 ± 2.7 days [95% CI: 7.94 to 9.44]; P ˂ .05) and its duration (5.11 ± 1.19 months [95% CI: 4.78 to 5.43] vs 7.14 ± 1.71 months [95% CI: 6.66-7.61]; P ˂ .05).</p><p><strong>Conclusions: </strong>The ABA group demonstrated an earlier onset and longer duration of the treatment effect. However, both types of BTX-A products, which are commonly used in dental clinics, provided statistically significant outcomes in terms of pain and maximum mouth opening.</p>","PeriodicalId":16612,"journal":{"name":"Journal of Oral and Maxillofacial Surgery","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144025081","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}